General Anaesthetics

General Anesthesia
“Global but reversible depression of CNS function
resulting in the loss of response to and perception of all
external stimuli”
Characteristics
– Analgesia
– Amnesia
– Attenuation of sensory & autonomic responses
– Muscle relaxation - Immobility
– Unconsciousness (no response to external stimuli)
History: ether/chloroform/N2O/cyclopropane/halothane
 Pre-anaesthetic Medication
Aims
– Relief of anxiety and apprehension
– Amnesia
– Supplement analgesia
– Decrease secretions and vagal stimulation
– Anti-emetic effect (peri & postoperative)
– Decrease acidity-avoid aspiration of gastric contents
– Reduce dose of gen. anesthetics
Timing & Route of administration (30 m-1h prior, I/V)
Pre-anaesthetic Medication
Sedative / Hypnotic / Anxiolytics
– Benzodiazepines (diff DOAs)
Diazepam (longest acting)
Lorazepam (0.05mg/kg)
Midazolam (0.07mg/kg)
– Barbiturates (100-200mg)
Secobarbital
Pentobarbital
Characteristics
1. relieve anxiety / relax pt.
2. sedate pt.
3. provide amnesia
Opioid Analgesics (10-20mg)
– Morphine (IV)
– Pethidine (IV)
– Fentanyl (transdermal patch) + congeners
Characteristics (delayed awakening,
constipation, asthma, urine retention,
excessive hypotension—morphine)
H2 Rec. blockers / PPIs (emergencies-dec.
gastric secr.-dec. aspiration pneumonia)
− Cimetidine & Ranitidine (150 mg)
− Omeprazole
Antiemetics
– Metoclopramide (10-20mg IM)
– Antihistamines (25-50mg)
– Phenothiazines (Promethazine)
– 5HT3 Receptor Blockers
Ondansetron
Tropisetron
Granisetron
Characteristics
– Used in cancer chemotherapy pts
Anticholinergics:
1. decrease secretions
2. inhibit vagal stimulation
– Atropine (0.4-0.6mg IV)
– Hyoscine (crosses BBB)
– Glycopyrronium (doesn’t cross BBB)
 Anti Histamines
─Diphenhydramine
─Dimenhydrinate
Characteristics (anti-emetics, sedatives,
anxiolytics & anti-cholinergics)
Used in combinations according to:
1. patient’s requirement
2. patient’s clinical status
3. type of operation
4. duration of operation
Classification of General Anaesthetics
Inhalational Anaesthetics
Volatile Liquids
Halothane, Isoflurane, Sevoflurane,
Methoxyflurane, Desflurane, Enflurane,
Ethyl chloride, Trichloroethylene,
Chloroform
Gases
Nitrous Oxide, Cyclopropane
Intravenous Anaesthetics
Ultra Short Acting Barbiturates
Thiopentone Sodium
Methohexital
Phencyclidine Derivatives
Ketamine
Steroids
Althesin
Eugenol Derivatives
Propanidid
Alkyl Phenols
Propofol
Etomidate
Neurolept anaesthesia (used in psychiatry)
Droperidol + Fentanyl + Nitrous oxide
 Stages of General Anesthesia
Guedel’s Signs – with Ether (not newer agents)
Stage-I Stage Of Analgesia
(no pain, drowsy, reflexes intact, no amnesia,
HR/BP normal, pupil size normal)
Stage-II Stage Of Excitement-most dangerous
(excited, delirious, RR inc., jerky movements –
injury, rapid eye movements, vagal stimulation -
cardiac arrest, catecholamines - arrhythmias)
Stage-III Stage Of Surgical Anesthesia
– Plane-I : pupils constricted, inc. regular resp.,
muscles relax, corneal/conjunctival reflexes lost
 Stages of General Anesthesia
– Plane-II : pupils dilate, dec. regular resp., eye-
balls fixed, dec. muscle tone, abdominothoracic
resp., no light reflex
– Plane-III : thoracic resp. ceases, pupils dilated,
muscles relaxed, laryngeal/pharyngeal reflexes
dec. – surgery performed in this plane
– Plane-IV : abdominal resp. ceases, all reflexes
lost – warning sign
Stage-IV Stage Of Medullary Paralysis (CVS &
resp. centers suppr – CVS collapse + Resp. failure)
Monitoring by anesthetist
 Inhalational Anesthetics

Mode of Delivery
– Open Drop method - Ether
– Anaesthetic machines assisted methods
Open System – accurate
Closed System – sodalime
- Trichloroethylene
Semiclosed System
 Inhalational Anesthetics
Depth of anesthesia
– Potency
Dose-response characteristics
MAC – definition
- example*
- Partial Pressure (PP) in brain
Pathway for General Anesthetics

INDUCTION

RECOVERY
 Pharmacokinetics
Administration, Uptake, distribution & elimination
Induction & Recovery***
– Rate of change of PP
FACTORS
Related to drug
– Concentration in inspired air
Fick’s law
– Solubility
In blood – Blood:gas partition coefficient**
- Inverse relation with induction
In tissues – Tissue:blood partition coefficient*
- Arteriovenous conc gradient
Related to body
– Pulmonary ventilation
Rate & depth
Hyperventilation / Resp depession
– Pulmonary blood flow / perfusion
Shock
– Alveolar exchange
Pul vent / perfusion
Lung disease
– Cerebral blood flow
CO2
 PROPERTIES OF INHALED ANESTHETICS
Anaesthetic Blood: Gas Minimal Metaboli- Comments
Partition Alveolar Conc sm
Coefficient (MAC) %

Nitrous Oxide 0.47 >100 None Incomplete anesthetic rapid

onset & recovery
Desflurane 0.42 6-7 <0.05% Low volatility; poor
induction agent; rapid
recovery
Sevoflurane 0.69 2.0 2-5% Rapid onset & recovery;
unstable in soda-lime

Isoflurane 1.140 1.40 <2% Medium rate of onset and

recovery
Enflurane 1.80 0.75 >8% Medium rate of onset &
recovery
Halothane 2.30 0.75 >40% Medium rate of onset and
recovery
Methoxyflurane 12 0.16 >70 % Slow onset & recovery
 PROPERTIES OF INHALED ANAESTHETICS
Anaesthetic Blood: Gas Brain: Blood Metabol Comments
Partition Partition -ism
Coefficient Coefficient

Nitrous Oxide 0.47 1.1 None Rapid onset & recovery

Desflurane 0.42 1.3 <0.05% Low volatility; poor

induction agent; rapid
recovery
Sevoflurane 0.69 1.7 2-5% Rapid onset & recovery;
unstable in soda-lime

Isoflurane 1.140 2.6 <2% Medium rate of onset and

recovery
Enflurane 1.80 1.4 >8% Medium rate of onset &
recovery
Halothane 2.30 2.9 >40% Medium rate of onset and
recovery
Methoxyflurane 12 2.0 >70 % Slow onset & recovery
 Elimination
Recovery Depends on
– Routes
Lung
Hepatic Metabolism**
– Concentration in lungs
– Variable tissue concentration
– Duration of exposure
Second gas effect : Nitrous oxide
Diffusion hypoxia : Nitrous oxide
Clearance & Metabolism
Mechanism of Action of General
Anesthetics
Old Theories
– Unitary Theory
– Meyer-Overton Theory
– Pauling’s Theory
– Ferguson’s Theory
– Mullen’s Theory
Newer Concepts
– Specific Targets
– Differential Sensitivity of Neurons- Stages
Newer Mechanisms
– Molecular Actions
Channels & Receptors
– Different binding sites
– GABAA receptor-chloride channels
Inhalational agents, barbiturates, propofol,
etomidate
– Glycine receptor-chloride channels
Inhalational agents, barbiturates, propofol
 – Glutamate receptor-NMDA channels
Ketamine, nitrous oxide, cyclopropane
– K+ channels (TREK) – Hyperpolarization
Inhalational agents, nitrous oxide,
cyclopropane
– Nicotinic receptor-activated cation channels
Inhalational agents
Neurotransmitters
– Acetylcholine
– Endorphin
 Halothane
Chemical and Physical Properties
– 2-bromo-2-chloro-1,1,1-trifluoroethane
– Volatile / odourless / colourless
– Non-irritant / non-explosive / non-inflammable
– Light-sensitive / corrosive / interaction - rubber
Pharmacokinetics
– MAC - 0.75
– B:G part. coef. - 2.3
– Medium rate of onset & recovery
– Metabolism – trifluoroacetic acid
- trifluoroacetylchloride
– Clearance (hepatic)
Pharmacological Effects
– CVS
↓BP / HR
Myocardial sensitization to catecholamines
Atropine / beta-blockers
Redistribution of blood flow
– Respiratory system
↑ RR, ↓ Tidal vol., dec. ventilatory response to CO2
Inc. PaCO2, raised apneic threshold
Bronchodilator – larnygeal/pharyngeal reflexes
abolished
– CNS
inc CBF & dec CMR
If CBF inc.—ICP inc.
EEG:initial activation-low dose, slowing-high dose
– Kidneys (dec. GFR & RBF), -GIT
– Liver (dec. portal bl. flow, raised LFTs)
– Skeletal muscles (relaxation, inc. curare eff)
– Uterus (conc. dependant relaxation)
Use
– Maintenance anesthesia – 0.5-1%
– Induction of anesthesia – 2-4%
– Used in children
– Low cost
Adverse effects
– Halothane shake/shivering during recovery
– CVS / Resp. sys depression
– Chronic toxicity - not carcinogenic/mutagenic
– Hepatitis
Pathophysiology: immune response
against triflouroacetylated proteins
Predisposing factors: elderly, obese,
females, electrolyte imbalance, enzyme
inducers, halothane exposure
Clinical S/S: nausea, vomiting, lethargy,
fever, rash, gen. weakness (days later)
Biochemical tests: eosinophilia, LFTs
deranged, autoantibodies,
triflouroacetylated proteins
Treatment: liver transplant in severe cases
– Malignant Hyperthermia
(seen with halothane & succinylcholine)
Pathophysiology:
autosomal dominant genetic disease
–Ryanodine Rec (RyR1) gene mutation
–L-type Ca+2 channels gene mutation
Clinical S/S: hyperthermia, hypertension,
hypercapnia, hyperkalemia, inc. HR,
metabolic acidosis, muscle rigidity
Biochemical tests: acidosis, hyperkalemia,
deranged electrolytes, inc. free cytosolic
Ca conc. in skeletal muscle cells (in vitro
caffeine - halothane contracture test)
Treatment :
Dantrolene (reduces Ca release from SR)
Symptomatic Rx for fever
Restoration of electrolyte & acid-base
balance
 HALOTHANE
ADVANTAGES DISADVANTAGES
POTENT NOT AN ANALGESIC
LESS IRRITANT VARIABLE MUSCLE
RELAXATION
INDUCTION SMOOTH AND SENSITIZES HEART TO
RAPID CATECHOLAMINES
QUICK RECOVERY HYPOTENSION
NON – INFLAMMABLE BRADYCARDIA
COMPATIBLE WITH SODA LIME HEPATITIS

BRONCHODILATOR RESPIRATORY DEPRESSION

UTERINE RELAXANT SHIVERING DURING RECOVERY
 ADVANTAGES DISADVANTAGES
LESS INCIDENCE OF POST- MALIGNANT HYPERPYREXIA
OPERATIVE NAUSEA/VOMITING

DOES NOT CAUSE ENZYME INDUCER

LARYNGOSPASM

EASIER ENDOTRACHEAL CORRODES METALS

INTUBATION DUE TO
RELAXATION OF MASSETER
MUSCLES

COST-EFFECTIVE REACTS WITH RUBBER

EQUIPMENTS
 ENFLURANE
Chemically it is halogenated ether
Non inflammable
Non irritant
Clear, colorless liquid with sweet odor
Blood : Gas coefficient 1.80
MAC : 0.75
Metabolism 8%
Stable with soda lime
Medium rate of onset & recovery
 ENFLURANE
Pharmacological actions:
CVS
Resp System
CNS
Renal System
Better Muscle Relaxant
Produces convulsions and involuntary movements
during induction or recovery
Liver damage is rare
Not recommended in children & epileptics
USE:
Maintenance of anesthesia. Not used in children
 ISOFLURANE
Volatile liquid
Non inflammable
B:G partition coefficient; 1.4
MAC : 1.4
Metabolism: 2%
Costly
Medium rate of onset & recovery
Pharmacological Actions
 ISOFLURANE
Most widely used volatile anesthetic.
Resemble Halothane Except:

Less incidence of hypotension

Less sensitization of heart to Catecholamines
Less toxic
Powerful Coronary vasodilator, may cause coronary
steal phenomenon
No pro-convulsive properties
Not cost effective
Irritant, resp depression
USE:
Maintenance of anesthesia
 DESFLURANE
Volatile halogenated compound
TEC 6, an apparatus required for vapourization
Non inflammable, Non explosive
Pungent smell (not for induction, but maintenance)
B:G partition coefficient: 0.42
MAC: 6-7
Metabolism: 0.05%
Rapid induction & rapid recovery (low B:G coeff)
Pharmacological actions
 DESFLURANE
Newer drug
Chemically similar to Isoflurane
Faster induction and recovery due to lower solubility
in blood ,so preferred for use in day case surgery
No significant metabolism
Less potent due to high MAC about 6 %
Concentration used for induction is 10 %.It can cause
respiratory irritation leading to coughing, salivation
and bronchospasm
USE:
Maintenance and ideal for outdoor procedures
 SEVOFLURANE
Clear, colourless, volatile liquid
Non inflammable, non irritant, pleasant smell
B:G 0.69
MAC: 2
Metabolism: 2-5% ( Nephrotoxic)
Rapid induction & recovery (low B:G coeff)
 SEVOFLURANE
CVS
Resp System
CNS
Renal System
Less toxic
Can cause malignant hyperthermia
USE:
Outpatient anesthesia & induction
 METHOXYFLURANE
Properties Same as Halothane Except:

Good muscle relaxation

Good analgesic effect
Slow induction & recovery
Cause severe renal damage
Not used any more
Desflurane
– Rapid onset & recovery
– Pungent / irritant
– Low volatility

Sevoflurane
– Rapid onset & recovery
– Nephrotoxic
Compound A - CO2 absorbent (soda lime)
- met. by beta-lyase (renal)
Hepatic – free inorganic Fl- produced
Enflurane
– Slow induction & recovery
– Potential nephrotoxic – beta-lyase
– Seizure-like activity (self limited)
Isoflurane
– Rapid onset & recovery
– Coronary circulation (vasodilation)
– Pungent (not used for induction, but
maintenance)
Methoxyflurane
– Nephrotoxic – met. by beta-lyase
- >30% hepatic met. - Fl-
– No longer used
Ethyl chloride
– Explosive, kept under pressure (low boiling point)
– Use – local anesthetic – cooling effect
- cryosurgery
Trichloroethylene
– Analgesia > Anesthesia
– Interacts with Soda lime – toxic metabolite
Chloroform (animal studies)
– Causes breath holding
– Hepatotoxic
– CVS depressant
 Cyclopropane
Potent GA
Non-irritant / explosive / flammable
(cautery couldn’t be used)
Severe CV collapse - Cyclopropane shock
Rx : small amount of CO2 administered
 Nitrous Oxide
Chemical and Physical Properties
– Inorganic gas (N2O)
– Odourless / colourless / heavier than air
– Non-explosive / non-inflammable / supports combustion
– Laughing gas: euphoria-small amounts, abused in past
Pharmacokinetics
– MAC - 105
– B:G part. coef. – 0.47 at 37 C
– Rapid induction & recovery
– Not metabolized (99.9% exhaled unchanged)
– Elimination (0.1% degraded by int. bacteria)
Pharmacological Effects
– CVS / Respiratory system (depends on other agents)
– CNS (inc. CBF – inc. ICP)
– GIT / Muscles
Uses
– Analgesia (40%)
– Sedation (30-80%)
– Anesthesia – less potency
- adjuvant
- second gas effect
- short surgical procedures
(dental extraction, postoperative pain, painful
dressings, fracture manipulation, child birth)
Adverse effects
– Diffusional hypoxia / anoxia
– Vitamin B12 deficiency (inhibits methionine
synthetase, req. for vitamin B12 synthesis)
Megaloblastic anemia
Peripheral neuropathy
– Replaces N2 in air-containing cavities (obstructed
middle ear, air embolus, pneumothorax) enlarges it
– Effect of NO2 & O2 in same cylinder (1st
insufficient anesthesia – later-on hypoxia)
 ADVANTAGES
Non-inflammable Non-irritating

Very Potent Analgesic: 30 – 40 % Analgesia

65 – 70 % Loss of consciousness

80 % plane one of Surgical

Anesthesia

Non-explosive, however supports combustion.

Rapid induction and recovery.

Use in procedures of short durations (tooth extraction,

obstetrical analgesia, cleaning and debridement of wounds).
Induction and maintenance of anesthesia

I/V Thiopentone-Gas-Oxygen-Halothane technique

Safe, no organ toxicity (Resp, CVS, Renal or Hepatic)

 the dose of GA when combined 

 adverse effects,  complications  recovery

period from anaesthesia
 DISADVANTAGES
Not a potent anesthetic & muscle relaxant
Violent excitement
Carbon dioxide accumulation and hypoxia  cardiac
irregularities during anesthesia
 DISADVANTAGES
Specialized apparatus to control its administration
Adm for more than 7hrs  Bone marrow depression (
leucopenia, anemia)
Prolonged adm  Peripheral neuropathy & Megaloblastic
anemia due to interference with B12 metabolism, Abortion,
peripheral Neuropathy
Second gas effect leading to transient hypoxia
Diffusion hypoxia
 NITROUS OXIDE
ADVANTAGES DISADVANTAGES
STRONG ANALGESIC LESS POTENT
RAPID INDUCTION TRANSPORTATION DIFFICULT
RECOVERY RARELY SPECIAL EQUIPMENT FOR
EXCEEDS 1-4 MIN ADMINISTRATION
NON IRRITANT PENETERATES INTO CAVITIES
NAUSSEA / VOMITING CO2 ACCUMULATION AND
UNCOMMON HYPOXIA ON PROLONGED
ADMINISTRATION
LITTLE EFFECTS ON MEGALOBLASTIC ANEMIA ON
CIRCULATION, PROLONGED ADMINISTRATION
RESPIRATION, LIVER, POOR MUSCLE RELAXANT
KIDNEY

COST EFFECTIVE DIFFUSIONAL ANOXIA

 Intravenous Anesthetics
Barbiturates
– Thiopental / Thiopentone Sodium
Induction / Onset
Narrow therapeutic index.
Ph is 7-10
Administered rapidly by I/V line
Onset of action 60sec
DOA 5-10min
α t1/2 3min (distr. t ½, resp. for DOA)
β t1/2 12hrs (elimination t ½, drowsiness)
PPB 85%
Pharmacological Effects
– CNS (dec. CMRO2 & CBF)
– CVS depressant (dec. CO & BP)
– Resp. sys depressant
– GIT
– Poor analgesia / muscle relaxation
– Renal system
Uses
– Induction
– Dental procedures
– Endoscopy
– Circumcision
– Orthopedic procedures
– Changing painful dressings
– Head injuries
– Psychoanalysis (truth drug)
Adverse effects
– laryngospasm, shivering & restlessness (recovery)
injection site pain, Inadvertent injection
– Acute porphyria, hypotension, apnea, resp
depression, hyperalgesia, local necrosis,
thrombophlebitis, gangrene
 THIOPENTONE
ADVANTAGES DISADVANTAGES
RAPID AND PLEASANT INSIGNIFICANT ANALGESIC
INDUCTION ACTION

EASY ADMINISTRATION VERY SHORT DURATION OF

ACTION
NON EXPLOSIVE REPEATED DOSES ACCUMULATE
LESS INCIDENCE OF CAN NOT BE USED ALONE AS AN
NAUSEA / VOMITING ANESTHETIC
NON IRRITANT COUGHING, HICUP,
LARYNGOSPASM,
BRONCHOSPASM MAY DEVELOP
DURING INDUCTION
QUIET RESPIRATION MUSCLE RELAXATION IS NOT
ADEQUATE (CONTD)
 ADVANTAGES DISADVANTAGES
NO SENSITIZATION OF PHARYNGEAL/ LARYNGEAL
HEART TO REFLEXES ARE NOT
CATECHOLAMINES ABLOLISHED
RAPID RECOVERY IN OVER DOSAGE DEPRESSION
OF VMC, MYOCARDIUM AND
RESPIRATION
NO EXCITEMENT REGURGITATION DUE TO
DURING INDUCTION RELAXATION OF
GASTROESOPHAGEAL
SPHINCTER
INJECTION MAY CAUSE
NECROSIS,
THROMBOPHLEBITIS, NERVE
DAMAGE, VASOSPASM ON
INTRA – ARTERIAL INJECTION
 Etomidate
Carboxylated imidazole
Pharmacokinetics
– Rapid onset / recovery
– T1/2 : distributive : 2-4 min
eliminative : 2.9-5.3 h
– Metabolism (Liver)
– Excretion (78% renal, 22% biliary)
Pharmacological Effects
-- little or no effects on CVS / Resp. sys
-- CNS (dec. CMRO2 & CBF)
-- no analgesia
 Etomidate
Use
– Poor cardiovascular reserve (old pts, IHD,
cardiomyopathy)
Adverse effects
– Injection site pain (Rx : lignocaine)
– Nausea, vomiting, restlessness, tremors
– Steroidogenesis inhibition esp. cortisol,by inhibiting
11B hydroxylation. This effect is transient if given for
short period but hypotension, electrolyte imbalance &
oliguria can occur on long use
Advantages

Minimum CVS Depression

Minimum Respiratory Depression

Larger margin of safety

Very rapid induction within seconds

Rapid recovery within 3-5 minutes

Disadvantages

No analgesic effect

Post operative Nausea & vomiting

Pain during injection

Myoclonus / involuntary movements during induction

Adrenocortical Suppression (with prolonged use)

 Propofol
Chemistry: 2,6 Diisopropylphenol
Formulations
– Conventional (oily)/ Ampofol / Fospropofol
(water-soluble prodrug)
Pharmacokinetics
– Onset (10-15 s) / recovery /Dose 1.5 -2.5 mg/kg
– T ½ : distributive : 2-4 min
eliminative : 4-23 hrs
– Metabolism / Excretion (Liver)
 Propofol

Pharmacological Effects
– CVS & Resp. sys depression
– CNS (dec. CMRO2 & CBF)
– Poor analgesia / muscle relaxation
Uses
– Induction & maintenance
– Ambulatory surgery (outpatient surgery)
– Sedation (less dose, endoscopy, ventilator pts)
– Dexmedetomidine *
Adverse effects
– CVS / resp. sys depression
– Injection site pain (propofol + lignocaine)
– Apnea, laryngospasm, myoclonus, tremors
Children with resp. inf.– acidosis (long use)
- neurological effects on withdrawal
 Advantages
Rapid Induction
Very rapid recovery as Compared to Thiopental,
without any significant hangover effect
Post operative nausea and vomiting is uncommon as
has antiemetic actions.
No cumulative effect.
 Disadvantages

Very expensive
Apnoea can occur
CVS depression
Pain at site of injection
Clinical infections
 Ketamine
Phencyclidine congener (racemic mixture of S & R)
Pharmacological Effects
– CNS
Blocks NMDA receptors (prevents glutamate
binding)
Psychoactive drug—abused as hallucinogenic
Inc.CBF, CMRO2 & ICP (avoid in head injury)
– Stimulates CVS – sympathetic stimulation + NE
reuptake block (peak: 2-4 min, normal: 10-20 min)
– Respiratory – doesn’t abolish reflexes,
bronchodilation– sympathetic stimulation + direct eff.
 Pharmacokinetics

Highly lipophilic , rapidly distributed in highly vascular

organs, potent, crosses BBB rapidly

Route I/V, I/M, Oral, Rectal

αt1/2 15 min

βt1/2 3 hrs
Onset of effect 2 – 5 min
DOA 5-10min
Metabolism
Dose 0.5-1.5mg/kg
Uses
Induction smooth but recovery unpleasant
– Dissociative anesthesia: analgesia, catatonia,
amnesia, hypnosis, unresponsive to painful stimuli,
sometimes involuntary limb movements
– Analgesia: short procedures
– Old age (poor CV reserves) / children
– Topical use (arthritic pains)
– Hemodynamic stability (cardiogenic/septic shock)
– Asthma / COPD (bronchdilation)
Adverse effects
– CVS: cardiostimulatory—avoid in IHD
– Emergence delirium: hallucinations (Rx: BZs)
 KETAMINE
Advantages Disadvantages
Effective by both I/V & I/M INJ No Muscle Relaxation

Anesthesia is accompanied by Tends to raise intraocular,

profound analgesia Intracranial BP and heart rate
Does not produce Vomiting Cannot be used for surgery on
Hypotension, Bronchospasm Larynx, Pharynx & Bronchi
Less respiratory complications due Poor in relieving visceral pain
to less impairment of Pharyngeal/
Laryngeal reflexes
Useful for poor risk geriatric pts Emergence phenomena
and in unstable pts
Used in low doses as outpatient
anesthesia
 NEUROLEPT ANESTHESIA

 It is a method of IV anesthesia which combines the use of a

neuroleptic drug with a narcotic analgesic drug.
 Administration of such a combination produces a state
which differs from the classical general anesthesia in that
the subject is conscious and is able to cooperate during the
operative procedure.
 The most common combination is that of Droperidol
(neuroleptic) and Fentanyl (opioid analgesic)
Fentanyl - 0.5-1 mg & Droperidol 2.5 -5mg/ml

Prep: INNOVAR Injection

NEUROLEPT ANALGESIA